冠状动脉内注射替罗非班对老年糖尿病急性心肌梗死患者的影响

Effect of intracoronary tirofiban on acute myocardial infarction in elderly patients with diabetes mellitus

目的探讨冠状动脉内注射替罗非班对老年糖尿病合并急性心肌梗死(AMI)患者急诊PCI的近期疗效和安全性。方法选择急诊PCI的老年糖尿病合并AMI患者97例,随机分为对照组(A组)49例、替罗非班组(B组)48例;另选择同期急诊PCI给予替罗非班治疗的非老年糖尿病合并AMI患者(C组)129例。对3组冠状动脉病变特征、并发症发生率等进行比较。结果与A组比较,B组和C组PCI术后TIMI 3级血流、心肌灌注3级明显升高(P<0.01),心肌灌注0～1级、2级、平均住院天数、梗死后心绞痛、恶性心律失常发生率明显降低(P<0.05,P<0.01)。3组单支、双支和3支病变、入院到球囊扩张平均时间、住院期间再梗死、支架内血栓、心源性休克发生率和30d病死率等无明显变化(P>0.05)。结论替罗非班能有效改善老年糖尿病合并AMI患者的TIMI血流和心肌灌注分级,降低梗死后心绞痛、恶性心律失常等并发症的发生。并不增加严重出血并发症。

Objective To study the short-term effect and safety of intracoronary tirofiban on acute myocardial infarction in elderly patients with diabetes mellitus （DM） accompanying acute ST elevation after percutaneous coronary intervention （PCI） in emergency department. Methods Ninety-seven elderly DM patients with acute ST elevation were randomly divided into control group （group A,n=49） and tirofiban treatment group （group B,n=48）. One hundred and twenty-nine non-elderly DM patients with acute ST elevation who underwent emergency PCI in our department and were treated with tirofiban served as group C. The characteristics and complications of coronary lesion in 3 groups were compared. Results The blood stream and myocardial perfusion of grade 3 coronary thrombolysis in myocardial infarction （TIMI） were significantly higher （P〈 0.01） whereas the grades 0--3 myocardial perfusion, average hospital stay time （days）, incidence of angina pectoris and severe arrythemia following myocardial infarction were significantly lower in groups B and C than in group A （P〈0.05, P〈0.01）. No significant difference was observed in the incidence of single, double and triple vessel lesions, average time from admission to balloon di- lation,incidence of recurrent infarction during hospital stay, thrombosis in stents, cardiogenic shock and 30-day mortality among the 3 groups （P〉0.05）. Conclusion Tirofiban can effectively improve the TIMI blood stream, reduce the complications of angina pectoris and severe arrythemia following myocardial infarction,but does not increase the complications of severe bleeding in DM patients with ST elevation.